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23. Diseases Peculiar to Men.

OF that quite numerous class of maladies which are peculiar to the male sex, by far the great majority are the result of some form of transgression of sexual law. The nature of these transgressions has been fully discussed in previous portions of this work, and what has already been said need not be reiterated here. The object of this chapter is to describe in greater detail than has been done in other portions of the work, the nature and symptoms of the various diseases of the male sexual organs.

The intimate association of all the various important functions of the body through the means of reflex nervous activity, lays the foundation for that profound and extensive influence upon the system at large which is observed to result from nearly all forms of sexual disease. It is, indeed, a common observation that local disorders so slight in character as to produce little or no inconvenience at the seat of disease, provoke, through morbid reflex influence, derangements in other portions of the body of the most serious and often most distressing character. Thus we not infrequently find, as the result of a slight irritability of the prostatic urethra, nervous debility, dyspepsia, emaciation, and a great variety of other marked and distressing symptoms. This fact emphasizes the importance of giving to this class of dis-

orders careful and thorough attention. Quite frequently they are overlooked or neglected, even for years. Perhaps the patient, through ignorance, imagines the symptoms which he observes, to be of little consequence, and thinks that they will pass away without special attention; or it may be that he is deterred by shame or false modesty from communicating the facts of his condition to his medical adviser, and thus a disorder which at the beginning might have been promptly corrected by the employment of the simplest measures, or perhaps would have required nothing more than a few words of good advice, by long continuance acquires a chronic form, and through the occurrence of tissue changes, becomes so thoroughly fixed that the most skillful and persevering treatment is necessary to effect its removal.

The popular idea that time cures most diseases, is erroneous. The fact is, time does not cure. Nature cures, but time kills. Such acute maladies as active congestion, fevers, inflammations, and the like, pass through a regular cycle of changes, and by the unaided efforts of nature, will usually end in recovery. Chronic maladies, on the other hand, to which belong most sexual diseases, are of a different character. Chronic disease tends almost invariably to the production of changes in the tissues which serve to propagate and intensify the disorder, thus leading farther and farther away from the standard of health.

The difference between acute and chronic disorders has been very aptly compared to that between a straight line and a circle. One traveling a circle, sooner or later arrives at the starting-point. This is the course of an acute disease. One who travels in a straight line, is

continually increasing the distance between himself and the starting-point. This is the course of a chronic disease. We wish to protest against the popular fallacy referred to, which leads hundreds to delay giving proper attention to the morbid symptoms which they experience, until so grave a condition is reached that recovery is impossible.

We do not wish to produce unnecessary alarm or anxiety on the part of any, and would discourage in the most emphatic manner that morbid seeking after symptoms, dwelling upon and exaggerating every little deviation from the natural condition of the body, which is commonly met among those who are suffering with maladies of the class considered in this chapter. In consequence, thousands of those who are suffering with the slightest ailments, imagine themselves to be much worse than they are. Great harm is done by those who unscrupulously take advantage of the ignorance and inexperience of these sufferers, and thereby produce, not only unnecessary alarm and distress, but an actual aggravation of the slight disorders from which they are suffering.

We cannot, in this chapter, consider the entire category of diseases to which men are peculiarly liable, but shall confine our remarks to those maladies which are of most common occurrence, and information concerning which will be likely to be of the greatest value. As has been previously stated, this work does not permit us to enter into the details of medical treatment which, in these disorders, may often be best left in the hands of a competent physician; or when they may be chiefly administered by the patient himself, should be directed by

one whose study and experience have fitted him to modify and adapt to each individual case the general principles of treatment which have been elsewhere laid down.

The principal object in presenting this chapter has been to thoroughly acquaint the reader with the signs of disease in the portions of the body considered, and the consequences of neglecting to give timely and thorough attention to these disorders before, by long continuance, they become difficult of eradication, if not wholly incurable.

Spermatorrhœa. — Used in its most general sense, this term applies to all forms of disease of the sexual organs accompanied by involuntary seminal losses. In a more technical sense, it relates only to a condition in which there is an unconscious escape of the seminal fluid connected with the passage of urine or movement of the bowels. It is in the latter sense that the term is here used. This disease is not so frequent as has been supposed by many; and on the other hand, it is not so rare an affection as many medical writers have seemed to think. There are those who claim to believe that the disease occurs so infrequently that it is scarcely worthy to be considered a distinct disorder. After carefully investigating several hundred cases of diseases peculiar to men, we have come to believe that it is by no means so rare a disease as is generally supposed to be the case, having determined the presence of spermatozoa by microscopical examination in a large number of cases in which a discharge occurred after urinating or while straining at stool.

Symptoms. — The leading symptoms of true spermatorrhœa

are headache; dullness of intellect; loss of power to concentrate the mind; defective memory; occasionally, partial deafness; roaring in the ears; giddiness; spots before the eyes; blurring of vision; short breath; sensation of weight or stricture in the chest; various forms of dyspepsia, such as sour stomach, or heaviness at the stomach; sleepiness after meals; constipation of the bowels; dry skin; abnormal sensitiveness of the skin; crawling, tingling, and other peculiar sensations of the arms or legs; twitching of the muscles; pressure in the back of the head; weakness of the eyes; general stiffness in the muscles, and lack of muscular vigor; back-ache, especially in the lower portion of the back, in the morning, or after muscular effort; great depression of spirits; melancholy; sometimes a disposition to commit suicide; insanity; unsteadiness of gait; severe pains in various parts of the body; flushing of the face; palpitation; loss of flesh; tenderness of the spine; pain in one side; impotence; numbness, coldness, and other abnormal sensations of the sexual organs, which are likely to be in a relaxed and shrunken condition, and of a bluish color; pain in the spermatic cord, and sometimes in the groin, and also at times a dragging pain in the testicles, which are sometimes tender; smarting or burning sensations when passing urine or afterward; a troublesome dribbling after relieving the bladder; unnatural excitability of the parts; twitching of the muscles at the fork of the thighs; frequent or involuntary erections; epilepsy; paralysis; symptoms of consumption. Lastly, as a symptom characteristic of this disease, we should mention the escape of a whitish fluid in greater or less quantities after passing urine or straining at stool.

In the majority of these cases there is to be found an exceedingly irritable condition of the prostatic urethra, and, indeed, not infrequently of the whole urethral canal. This may be discovered by passing the finger into the rectum, and pressing against the prostate gland and the tissues just in front of it. In severe cases, a pressure upon the perineum and the under surface of the penis, close to the body, will show exquisite tenderness of these parts. An intense burning or smarting on passing urine is frequently present, indicating the same condition.

It must not be supposed that all the above symptoms are present in any one case; but a large majority will be found in well-pronounced cases of this disorder. Sometimes stricture may be present.

Spermatorrhœa sometimes exists, not as a primary disease, but as a symptom of some other disorder. It is frequently present in extreme cases of nervous exhaustion, in convalescence from fever, the debility arising from pulmonary consumption, and in some cases of hemorrhoids or other forms of rectal disease.

It has been suggested that the tendency to this disease may be inherited. It is unquestionably true that some persons are much more liable to the disorder than those who do not possess the peculiar predisposing excitability which is so often present in this class of cases.

False Spermatorrhœa. — It must not be supposed that true spermatorrhœa exists in every case in which a slight discharge is noticed when straining at stool or after urinating. Probably the majority of cases in which this symptom occurs, though requiring serious attention, do not properly belong in this category. A

slight discharge of this kind is a very common result of an incompletely cured gonorrhœa or gleet. Not infrequently, when a discharge of this kind has existed previously, and has been apparently cured, excessive sexual indulgence, taking cold, a constipated condition of the bowels, or a concentrated and irritating condition of the urine, may cause it to reappear. The discharge usually indicates a diseased condition of the urethra, any portion of which may be affected, though the prostatic portion is by far the most likely to be the part diseased. In some cases, however, the difficulty is located in the vesicula seminalis, the lining membrane of which, like other portions of the urethral and genital passages, is subject to catarrh as the result of cold, undue sexual excitement, or continuous inflammation.

Among the results of spermatorrhœa must be reckoned the very worst of those physical and mental disasters which have been enumerated in previous portions of this work as resulting from self-abuse and other sexual a excesses. A very common result, but one which has been until quite recently overlooked, is stricture. This severe and painful disorder most commonly occurs as the result of the violent, acute inflammation of gonorrhœa, especially when prolonged in the form of gleet. In cases of spermatorrhœa, however, it appears to be the result of long-continued congestion and irritation of the mucous membrane of the urethral canal, resulting in changes in the mucous membrane, which sooner or later produce more or less narrowing of the parts, or stricture. The amount of stricture produced in this way is not often so great as to produce complete obstruction, and is quite likely to be overlooked; but it may be quite sufficient

to occasion a vast deal of suffering, and set up morbid processes in the bladder and other urinary passages, the result of which may be the worst possible.

The possibility of the existence of this condition renders it important that every person suffering from this disease should consult a thoroughly skilled and competent physician, in order that the real state of his case may be ascertained.

The causes of stricture are such as have been already enumerated in previous portions of this work. Self-abuse and excessive venery are unquestionably its prime causes; and when these exist, no measures of treatment are effective, unless all the causes are removed. All the hygienic measures which have been enumerated elsewhere as essential to the successful treatment of the results of self-abuse, must be brought to bear in these cases. Whenever possible, the patient should place himself under the care of a conscientious and skillful physician. The weakened will-power and loss of moral tone which usually exist in these cases, render the services of a physician most important, as very few of those suffering in this way have sufficient self-command and decision of character to pursue, for any length of time, the rigid and systematic efforts necessary for the eradication of the effects of long-continued wrong doing.

The opinion expressed by many physicians when called upon by patients suffering in this way, that the disease is one of little consequence, and probably does not exist at all, often leads to great mischief; and certainly, when such an opinion is given without a close and critical investigation of the case, the patient may well doubt the individual's competence to deal with dis-

orders of this class. Those who have had much to do with cases of this sort, have become thoroughly convinced, not only of their great frequency, but of the fact that their successful treatment requires the most painstaking efforts, and the exercise of the highest skill, not only in the selection and the application of remedial measures to the diseased parts, but in the education and discipline of the patient so as to secure his full co-operation in carrying out those measures of treatment and regimen elsewhere suggested, such as proper diet, exercise, abstinence, etc., which are more important than any medicinal remedies that can be employed.

In the treatment of this disease, it should be thoroughly understood that the danger to the system consists, not in the loss of seminal fluid, though unquestionably this is a serious drain upon the vital forces of patients suffering in this way, but in the nervous exhaustion arising from reflex nervous action, which ultimately results in general debility and derangement of the whole system. The irritable condition of the diseased surfaces of those portions of the urethra usually affected, occasions a morbid irritability of the nerve centers of the lower portion of the spine, which have charge of this part of the body, and from this the irritation is propagated to other portions of the central nervous system. It is by this means that the digestive organs, lungs, heart, and in fact every portion of the body, suffer, even in an extreme degree, as the result of this disorder. Such methods of special treatment should be employed as have been indicated in previous portions of this work, in which the subject has been discussed as fully as the character and scope of the volume will permit.

Seminal Weakness or Nocturnal Losses. — The great prevalence of masturbation among boys and young men, and marital excesses among married men, has rendered the existence of genital weakness so common that many physicians have come to believe that the occurrence of seminal losses during sleep is a perfectly normal condition, if not too frequently repeated. Extensive observation, however, has convinced the writer that this opinion is an error, and that in a man who is in perfect health, physically, mentally, and morally, such a thing as involuntary seminal losses will not occur, either sleeping or waking.

This diseased condition, for such we consider it to be under all circumstances, is not solely the result of self-abuse, however, as it may arise from any form of sexual abuse, as has been pointed out in previous portions of this work. Unquestionably, the underlying cause of the disease consists in a great number of circumstances relating to diet, matters of regimen, social surroundings, etc., pertaining to our modern civilization, which are directly calculated to stimulate the sexual propensities to abnormal activity.

The occurrence of an emission during sleep, indicates excessive irritability and want of nerve tone on the part of the nerve centers controlling the sexual organs. In a state of health, the influence of the brain or the nervous system alone is not sufficient to produce seminal ejaculation, the natural stimulus of coitus or the abnormal one of masturbation being required to compel the receptacles of this most precious of all vital fluids to yield up their contents. When the controlling nerve centers have been weakened by disease, however, and still further weakened

by the general lowering of nerve tone during sleep, even the slight stimulus of a passing dream may be sufficient to produce the involuntary actions by which the emission is occasioned. In many cases in which the disease has not reached this advanced stage, the emission does not occur during sleep except when conditions especially favoring it exist, such as the presence of undigested food in the stomach, loaded bowels, a full bladder, supine position, excessive heat from too much covering, or some similar cause of abnormal sexual excitement. After the disease has made further advancement, however, causing all additional loss of tone on the part of the sexual centers, the circumstances mentioned, while still favoring the occurrence of the emissions, are not essential to provoke it, as it will often occur with most distressing frequency, even when all unfavorable conditions are carefully avoided.

After the malady has made still further progress, the nerve centers become weakened to such a degree that the same involuntary discharge may occur through the excitement of impure thoughts, even while the patient is wide-awake. Another step in advance, and that most deplorable condition is reached in which seminal losses occur without erotic thoughts, and even without the slightest degree of sexual excitement of any sort, a condition known as spermatorrhœa, or spermatorrhagia, which is considered under another head.

Symptoms. — The leading symptoms of this disorder are pain in the lower portion of the back, various forms of headache, debility, pressure at the back of the head, fullness in the forehead with a general sense of oppression in the head, confusion of thought, dullness of mind,

want of mental or physical energy, mental abstraction, irritability of temper, nervousness, fickleness, morbid fears, melancholy, roaring and various sounds in the ears, specks before the eyes, tenderness of the eyeballs and sensitiveness of the eyes to light, dark rings under the eyes, muscular twitching, wandering pains in various parts of the body, numbness and other peculiar sensations in the arms and legs, symptoms of indigestion, constipation of the bowels, sediment in the urine, irregularity of the urinary excretion as to quantity, great sexual excitability or sexual apathy, seminal losses occurring during sleep either with or without dreams, smarting and burning of the urethra during or after urinating, dribbling after urination, sense of weight, pain, or uneasiness in the testicles, tenderness or dull pains in the perineum or fork of the thighs, and various other symptoms too numerous to mention.

It should be stated, however, in this connection, that not infrequently the patient attributes to this disorder many symptoms which are wholly foreign to it, and which arise from other diseases that happen to be present with it. The patient is pretty certain to make close and frequent examinations of the sexual organs, and to notice the slightest deviations from what he considers to be the standard of health, as the result of which he not infrequently becomes unnecessarily alarmed, imagining that there is wasting of the parts, or other abnormal conditions which do not really exist. This tendency is greatly encouraged by the quackish advertisements found in the newspapers and scattered about the country in lying circulars, sent out by mercenary charlatans, in which are to be found grossly exaggerated de-

scriptions of the disease and its effects, which are well calculated to excite in the highest degree, ignorant and susceptible young men who may be suffering with any of the symptoms of this disease.

A question of importance must not be overlooked in this connection: How frequently may emissions occur without occasioning injury? As has been previously said, an emission is an indication of an abnormal condition. However, the abnormality does not amount to what might properly be called a disease, when the occurrence is only occasional, and is not followed by any chronic general or local disturbance. When, however, an emission occurs with only a few days interval, or when the occasional occurrence is followed by general discomfort and physical and mental depression or irritability. or such local symptoms as smarting after urination, dribbling after passing urine, etc., serious injury is being done, and the individual should consider it necessary to place himself under treatment. It may be said, in general, that the occurrence of an emission more often than once in three or four weeks is evidence that the morbid condition present is sufficiently serious to require medical attention. This statement will be met by the claim that plenty of cases may be cited in which losses have occurred with much greater frequency than this, for long periods, without apparent injury; but sooner or later other evidences of disease make their appearance. In all these cases, injurious results make their appearance sooner or later, if not in any other way, in the loss of sexual vigor and the occurrence of prostatic and other troubles which either do not occur at all in a healthy person, or are postponed to a late period of advanced life.

In the treatment of many of these cases, we have invariably noticed as one of the first symptoms of improvement that though the seminal losses still continued without great diminution in frequency, the patient no longer suffered the great depression of mind and body which had previously followed their occurrence. This is a sign of improvement in general nerve tone, by means of which the disorder will be ultimately controlled. This change in the advance of the disease toward health, is directly the reverse of that which occurs in the march of the disorder in the opposite direction. Patients may often imagine the emissions are doing no harm, though occurring with great frequency, simply because they do not feel any serious effects. But this is only because the general vital tone is sufficiently great to withstand for a time the exhausting drain upon the system; but sooner or later, nervous bankruptcy will supervene, and the patient will appreciate his true condition.

As regards the treatment of this disorder, it is not necessary to repeat what has been said in previous portions of this book, and we cannot attempt to treat the subject in anything like a complete manner, not only because our space is limited, but because such a treatise would not be in conformity with the general character of this work. The following, however, is what almost any young man may do to aid himself in recovering from this disease, in addition to such measures as may be suggested by a competent physician who has been made thoroughly cognizant of the peculiarities of the case: —

1. Diet. — Eat only plain and simple food. Avoid all highly seasoned and stimulating articles of food, such

as sauces, pepper, pepper-sauce, mustard, and condiments generally. Also avoid eating too fast, overeating, and eating hearty and late suppers. Whole-grain preparations, such as oatmeal, graham mush, cracked wheat, graham bread, etc., should be freely used, together with ripe fruit. Meat should be taken sparingly; and when there is considerable local excitability and irritation, it should be avoided altogether. All kinds of alcoholic liquors, including wine, beer, and hard cider, must be scrupulously avoided, also the use of tobacco in any form. Strong tea and coffee are highly injurious. The diet should be made abstemious. Better too little than too much.

2. Exercise. — Plenty of exercise in the open air should be taken daily. When the employment is sedentary, dumb-bells, Indian clubs, and other forms of gymnastics are of great value, and should be taken regularly. The amount of exercise taken each day should be equivalent to walking from six to fifteen miles, according to the strength. Vigorous walking is one of the best forms of exercise. It is not well, as a rule, to take a great amount of exercise before breakfast. Exercise may often be taken to advantage just before retiring at night. It is useful at this time as a means of securing a healthy fatigue, which will insure sound and refreshing sleep.

5. Mental Conditions. — The mind should be controlled with the utmost rigor. Impure thoughts should not be harbored for a moment. The mind should not be occupied in the evening with anything of an exciting nature.

4. Treatment. — Take a good, thorough sponge or full bath, using soap, and rubbing vigorously with a coarse

towel, twice a week. Take a hip bath at 100° three times a week, just before retiring at night if convenient. Continue the bath about fifteen minutes. Hot and cold applications to the lower portion of the spine three or four times a week, will also be found beneficial; and when there is great local excitability or smarting after urinating, hot applications may be made to the perineum with advantage, using a sponge wet in hot water. When the bowels are constipated, wear an abdominal bandage, which should be applied by means of a towel wet in cold water and wrung-out as dry as possible. Wind it around the body, and cover with a flannel bandage long enough to go two or three times around the body. Change morning and night. After wearing one week, intermit during the day time. Knead and purcuss the bowels two or three times a day; and if very obstinate, resort to the warm water enema, which can be most conveniently taken by means of a fountain or siphon syringe.

Drink six or eight glasses of hot water in the course of the day. One hour before a meal, or two or three hours after, is the best time for taking the water. A glass or two may be taken with advantage just before retiring at night. If there is a tendency to atrophy or shrinkage of the parts, alternate sponging in hot and cold water daily for ten or fifteen minutes will be found beneficial.

Diurnal Losses. — Under the head of diurnal emissions or losses are included every form of seminal discharge occurring involuntarily during the waking hours. These discharges are very diverse in character. They usually occur just before or just after the passage of urine, or

when straining at stool. However, in the majority of cases, they are not seminal in character, though there may be an occasional loss of seminal fluid. This fact may be ascertained by placing a small portion of the discharge upon a slip of glass, and putting it in the hands of a good microscopist for examination. We have made many examinations of this kind, and while a trace of seminal fluid has been frequently found, we have been able to assure most of these patients that the discharge which they supposed to be seminal in character, and which had given rise to the gravest apprehensions, was really wholly of a catarrhal nature, and only significant as indicating a diseased condition of some portion of the urinary or genital passages.

These discharges should not be looked upon, however, as insignificant, and not worthy of attention, as they are always indicative of disease. The nature of the disease presents as various forms as do the discharges themselves. Several varieties are observed, which may be enumerated as follows: —

1. The most common of all discharges of this kind is a clear, viscid secretion, much resembling the white of an egg, which escapes from the orifice of the urethra either before or after urination, or after an erection, following some degree of sexual excitement. This discharge is from the small glands located in the prostatic urethra, and is a perfectly natural secretion. Too great an amount, however, indicates abnormal irritability of the membrane of the locality from which it comes, and hence is deserving of attention.

2. An opaque mucous secretion which is formed in the seminal vesicles. This secretion may be either due to

catarrh of the parts named, or may be a natural secretion squeezed out by the pressure of hardened feces in the act of moving the bowels. A similar discharge, noticed after urinating and after a movement of the bowels, may be the result of a chronic irritation or inflammation of some portion of the urethral canal, and in such a case requires thorough and careful treatment.

3. Lastly, we mention a milky looking fluid, in quantity varying from one or two drops to half a teaspoonful, escaping at the beginning or end of urination, which is found to contain a greater or less quantity of spermatozoa.

All discharges from the urethra are liable to contain spermatozoa in greater or less quantities, either as the result of a relaxed condition of the openings of the ejaculatory ducts, which allows the semen contained in the seminal vesicles to escape, or often as the result of constipation of the bowels, the seminal fluid being mechanically forced out of the seminal vesicles by the pressure of the hardened contents of the bowels. These discharges may occur with very great frequency, or only at long intervals. When of very infrequent occurrence, their significance is not very great; but when, as is sometimes the case, they occur daily, the condition should receive prompt attention.

Sometimes the discharge of seminal fluid is backward into the bladder, and so mixed with the urine that attention is not called to it, and the patient is wholly unaware of the mysterious disease which is undermining his health, and goes from one physician to another seeking to find the real cause of his malady and the proper remedy, but obtaining no relief. We have met a number of

cases of this sort, in some of which the amount of seminal fluid lost in this way, and the constancy of the symptom, quite exceeded any conception which we had previously formed of cases of this sort. The only method of detecting these cases is for the physician to adopt as a routine practice the plan of making a careful microscopical examination of the urine in every case.

All urethral discharges, of whatever character, should be subjected to careful microscopical scrutiny, as by this means only, can their real character be determined. We have frequently found seminal fluid present when it was least suspected, and when the small quantity discharged was supposed to be simply a little urethral mucus or prostatic fluid. The significance of these discharges is not in proportion to the quantity. Even the very slight amount of discharge, if constantly present, is indicative of a morbid condition, which may in time give rise to the very worst results. When such a discharge accompanies seminal losses, or any other form of sexual weakness, it must certainly be removed before the accompanying difficulty can be entirely relieved. The sediment which appears in the urine, as a general thing, has nothing to do with the discharges. These sediments usually consist of phosphates or urates, though sometimes there is more or less mucus present. When this is the case, whitish threads will be observed to float upward from the mass collected at the bottom of the vessel. When the deposit consists of urates, the urine is clear when first passed, the sediment only appearing after the urine has cooled. Phosphates appear in the urine when first voided, often giving to it a milky appearance, the cause of which is likely to be attributed to the presence of a large quantity

of seminal fluid. It is exceedingly rare, however, that spermatozoa are present in so great a quantity as to give the urine this appearance.

The ordinary results of these emissions, when long continued, are the following: —

1. The most constant of all the morbid conditions resulting from this discharge is a weakened condition of the organs affected. The functional activity of the sexual organs is perhaps more easily disturbed than is found to be the case with any other organ or system of organs in the body. This is the wise provision of nature for the protection of the rest of the body, which suffers more profoundly from excessive exercise of the sexual function than from any other form of abnormal functional activity. Hence, when great excesses of this sort are indulged in, nature kindly takes away the power for indulgence, and thus prevents that utter destruction of the body which results from the continued exhausting drain to which the system might otherwise be subjected. When diurnal emissions of any sort occur, the sexual organs are also seriously diseased, and morbid processes are at work which are very certian{sic} to result ultimately in serious loss of sexual vigor. Cases in which the discharge is distinctly of a seminal character, were formerly considered to be practically hopeless; but by proper management, and with the aid of improved methods, these cases are known to be amenable to treatment, and it is probable that nearly all cases, if not every one, may be substantially cured by the adoption of the proper measures.

2. General nervous debility is another of the most prominent results of these losses. This arises, not so

much from the drain upon the system of the frequent discharge, but from the morbid reflex influence of the local irritation, which gives rise to the discharge. The patient is much given to melancholy, and sometimes approaches almost to the border-line of insanity in consequence of the mental distress arising from the knowledge of his real condition, or from apprehension of a condition more grave than that which really exists.

3. Various diseases of the bladder and portions of the urinary passages are often present in these cases, and very frequent, difficult, or painful urination. Smarting or burning at the beginning of the act of urination is a very constant symptom, to which is usually added a persistent and annoying dribbling of urine after evacuation of the bladder. This is due to the relaxed and weakened condition of the muscles of the urethra, and their failure to contract promptly, so as to expel the last portion of the urine. A similar condition of relaxation affects the mouths of the ejaculatory ducts, which causes them to remain open, allowing the escape of seminal fluid.

4. Dyspepsia in some one of its various forms is very frequently an accompaniment of this disorder, and is a direct cause of a great share of the debility and distress arising from it, which are usually attributed to the seminal losses, though not directly due to them.

When a person discovers himself to be affected with discharges of this sort, he should consider the matter one deserving of immediate and careful attention until every vestige of the disease is removed. The penalty of neglecting to attend to the matter with promptness will usually be, in the most favorable cases, early loss of

sexual vigor, and in the great majority of cases, some worse form of sexual disease, and all the various accompanying symptoms which have been pointed out. The only methods of treatment which can be advantageously employed by the patient himself are such as have been already described as useful in other forms of sexual disease.

The question of marriage has been discussed elsewhere in this work; but we cannot allow this opportunity to pass without reiterating the warning that a person suffering in this way should never think of marrying until the local disease has been substantially cured, as the deepest regret and intensification of suffering are almost certain to result when a contrary course is taken.

Diseased Prostate. — One of the most common accompaniments of the disease previously described, is some form of prostatic disorder. Perhaps the most common of these is irritable prostate, a disease in which the affected part is sensitive to pressure, as may be discovered by introducing the finger into the rectum, and pressing in the direction of the bladder. The irritability is sometimes so great as to occasion pain or uneasiness in sitting, there being constantly a dull, aching pain in the perineum, or fork of the thighs. This condition may be the result of chronic or acute inflammation, but most often results from sexual excesses of some form. In cases of nocturnal losses or spermatorrhœa, this condition is a frequent cause of the continuance and aggravation of the disorder, occasioning undue excitement of the parts, and weakening of the nerve centers which have control over these organs, lowering their tone, and thus engendering the very conditions upon which this disorder

chiefly depends. Persons suffering in this way generally complain of smarting during or after the evacuation of the bladder.

Acute Inflammation of the Prostate is generally the result of excessive sexual excitement, alcoholic indulgence, extension of gonorrhœal inflammation, or severe treatment of the urethra by means of irritating injections, and the careless use of sounds. Exposure of the parts to dampness and cold, as in sitting upon the ground or a wet board, has occasioned the disease.

The most common symptoms are a sensation of weight and fullness about the rectum and perineum, and an urgent desire to pass water, with uneasiness at the neck of the bladder. When the urine is passed, more or less pain is experienced at the close of the act. When the inflammation attains a high degree of intensity, the pain becomes throbbing and shooting in character. There is a sensation of great fullness and tenderness in the parts, also pain in the back when sitting. Great pain is experienced in the movement of the bowels, and in severe cases there may be obstruction of the urinary passages. The patient may suffer from chilliness, and generally has more or less fever. If the finger is placed in the rectum, the prostate gland is found to be more or less swollen and throbbing. If the patient remains quiet in bed, the recovery is generally quite speedy, though the gland is often left in an irritable and enlarged condition, and is liable to the occurrence of similar attacks, or the continuance of the inflammation in a chronic form, in which the same symptoms are experienced, though with a less degree of intensity. There is also more or less discharge, cloudiness of urine,

and much difficulty and pain in passing the urine. Excessive exercise and the use of irritating foods aggravate the symptoms in the chronic as well as the acute form of the disease.

Enlargement of the Prostate is usually the result of acute or chronic inflammation, though it is not infrequently found in elderly persons and those who have been addicted to great excesses, without the occurrence of the acute form of the disease. Enlargement of the prostate is considered by some to be a necessary accompaniment of old age; but this is certainly not the case, though it is probable that fully one-third of all men who have attained the age of fifty years have more or less enlargement of the part.

Many persons have a considerable degree of enlargement of the prostate without being aware of the fact, the increase in size being so gradual that it is not observed until so great a degree of obstruction to the passage of urine is produced as to require a considerable degree of voluntary expulsive force. The size of the stream is not usually lessened, but the force is greatly diminished. The patient urinates with much greater frequency than usual, and as the disease advances, considerable irritability and discomfort in the rectum is occasioned by the frequent and violent straining efforts required to evacuate the bladder. After a time, the obstruction becomes so great that the bladder cannot be fully evacuated by any effort on the part of the patient. When it becomes greatly distended, a small quantity of urine may be forced out by violent efforts, and during sleep a sort of overflow occurs, which may be the first symptom to which the patient's attention is seriously

directed. The retained urine decomposes, becoming alkaline, irritating the mucous membrane, and setting up a catarrh or inflammation of the bladder and a great variety of attendant disorders and inconveniences which, if neglected, may lead to fatal results. We have frequently met cases of this kind in which the bladder contained almost incredible quantities of urine which had probably been retained for weeks. In some cases, possibly the bladder had not been fully emptied for months.

The very same measures which have elsewhere been recommended for local congestion, particularly hot sitz baths, hot fomentations to the lower portion of the spine and the perineum, are among the most useful measures in these cases. The same regimen as to diet should be followed as has been indicated for other sexual disorders, particularly the avoidance of all stimulating foods, tobacco, alcoholics, tea, coffee, etc. It is important, however, that the patient should avoid violent exercise, and that total abstinence as regards sexual indulgence should be observed until the disease is thoroughly cured.

Stricture. — A contraction, or stricture, of any portion of the urethral canal is usually the result of the acute inflammation of gonorrhœa, or the chronic irritation and inflammation of gleet. All grades of stricture exist in different cases, from a very slight narrowing of the canal, to complete obstruction. The idea that a stricture does no harm if it does not very materially obstruct the passage of urine, is a popular error which should be corrected. Any considerable degree of narrowing of the canal, whether sufficient to present a

serious obstacle to the evacuation of the bladder or not, is a serious matter, and requires the attention of a competent surgeon. Such a contraction is usually sufficient to maintain a gleety discharge, and a chronic irritability which is likely to result in early loss of sexual vigor, or some other form of sexual disorder.

Stricture is not always the result of gonorrhœa or acute inflammation of the urethra, but may, and frequently does, result from the practice of self-abuse, or may often be occasioned by a long continuance of nocturnal emissions which may have been occasioned by mental incontinence, even when masturbation has never been practiced. The earliest symptoms of stricture are pain and smarting at some point of the urethra during or after the passage of urine, this part being usually the seat of the stricture; a slight discharge; frequent urination; the peculiar form of the stream of urine, which may be twisted forked, divided, or squirting. Change in the form of the stream should not, however, be looked upon as a positive symptom of stricture, as it is not infrequently occasioned by swelling of the lips of the orifice of the urethra. Pain in the testicles and back, and irritation and protrusion of the rectum are frequent results of violent straining. Retention of the urine is also a frequent symptom. Sometimes, in consequence of retention of the urine, it becomes foul in the bladder, producing irritation of the mucous membrane, and subsequently catarrh of the bladder. In these cases, the mucus appears in the urine as a whitish deposit, shreds of which float through the urine. Blood is sometimes passed, especially in cases in which the catheter is frequently used. In advanced cases, the stricture becomes

so close that the urine can be passed only in drops; and after a while, constant dripping occurs, due to overflowing of the bladder, which the patient is unable to empty by voluntary effort. The bladder becomes greatly distended, and sometimes nearly paralyzed. Great injury is occasionally done through rupture of the urethra, from the violent straining efforts of the patient. There is generally great impairment of the general health in these cases. The patient complains of various disorders of the digestive organs, great pain in the loins and back, chilliness, followed by fever, especially after the use of the catheter, which sometimes produces symptoms so serious as to give rise to what is known as urethral fever.

The treatment of stricture is a matter which belongs exclusively to the skilled surgeon. The man who has any suspicion whatever that he is suffering with even a moderate degree of obstruction of the urethral canal, should at once seek skillful surgical advice. Sometimes the narrowing of the urethra may exist only at the orifice, and yet serious results may follow if the matter is neglected.

Balanitis. — Persons who have a long and rather tight foreskin, frequently suffer from inflammation of the mucous membrane which covers the glans penis, or foreskin. The symptoms are severe burning or itching of the affected parts, frequently accompanied by violent erections and great sexual excitement. The foreskin is red and swollen, sometimes to a very great degree. A yellowish or whitish discharge of a very disagreeable odor is also present. The most common cause is neglect to keep the parts thoroughly cleansed. The only treatment required in the majority of cases is thorough

cleansing of the parts three or four times a day with tepid water. If the disease persists, a slightly astringent lotion may be applied, and if it is found impossible to prevent the disease by daily cleansing, a portion of the redundant prepuce should be removed by a surgeon.

When cases of this sort are neglected, thickening and narrowing of the foreskin is frequently the result, and this is sometimes so great as to be an obstruction to the passage of urine. We have met cases in which the result was an adhesion of the foreskin to the glans penis.

Venereal Warts. — These morbid growths, which are usually found upon the edge of the glans or some portion of the foreskin, are not essentially different from the warty growths which are to be found upon other portions of the body. They may occur in chaste persons as well as those who have been addicted to venereal excesses, though the latter are much more liable to suffer from this sometimes very obstinate disorder. The disease is thought by some to be contagious, but it is perhaps a question whether this point is fully established. These warts may be successfully treated by the employment of the same means as would be employed in case of warts on any other part of the body.

Phimosis. — This is a condition in which the foreskin is so tight that it cannot readily be drawn back over the glans penis. In some cases, the orifice is so small that there is barely room for the passage of the stream of urine in the evacuation of the bladder. A person may be born with this condition, or it may be the result of long-continued inflammation or irritation. This matter is one which should receive attention, as the

irritation arising from phimosis may occasion various sexual disorders, particularly nocturnal emissions, a disease which is always aggravated by it, though originally induced by other causes.

As soon as discovered, this condition should be removed by the proper operation. It is rarely necessary to resort to the old method of circumcision, as the same results may be obtained by a less formidable and painful operation.

Paraphimosis. — This condition is one rarely met with except in cases of venereal disease, though some years ago we encountered a very severe case in the person of a little boy who was suffering from partial phimosis, and having accidentally drawn the, prepuce over the glans, was unable to return it. In a short time, so great swelling occurred that sloughing of the parts was threatened, when his father brought him to us for relief. Persons suffering with paraphimosis should not incur the risk of an accident of this sort. When paraphimosis exists, a physician should be called, unless by careful manipulation of the parts they can be readily restored to their normal condition.

Hydrocele. — This condition, sometimes incorrectly called dropsy of the testicle, consists in an excessive accumulation of natural secretion within one of the coverings of the testicle. The enlargement is usually pear-shaped, with the large end downward, and differs from hernia in its form, the tumor of hernia being larger at the upper instead of the lower part. When allowed to exist for years, hydrocele frequently causes a wasting of the testicle, and hence should receive attention as soon as it makes its appearance. It is not necessary to

describe the methods of treatment required for this disorder, as a competent surgeon should be consulted.

Varicocele. — This condition consists of a varicose condition of the spermatic veins. It is a very frequent malady, probably one-tenth of all males being affected with it. In chronic cases, the disease is accompanied by more or less inflammation of the walls of the veins, causing thickening. The mass of veins sometimes attains an enormous size. Aside from the enlargement, the most common symptoms are pain in the testicle and groin, and a constant dragging sensation, especially when standing upon the feet, or engaged in active exercise. In many cases these symptoms are not present to such an extent as to occasion any inconvenience during the cold months, but are very troublesome during the warm season of the year. The disease may be occasioned by the same causes which produce a varicose condition of the lower extremities, such as long standing upon the feet, or excessive walking. A very common cause is straining at stool. The disease is probably most frequent in those who have been addicted to self-abuse and other sexual excesses, though it is by no means confined to this class. Varicocele occurs most frequently on the left side, which is probably due to the absence of valves in the left spermatic vein.

The palliative treatment of this disorder consists in frequent bathing of the parts in cold water, and wearing a proper suspensory bandage to support the scrotum and its contents. The only radical method of cure consists in ligation of the spermatic veins. The old method of doing this operation was somewhat hazardous, and only justifiable in severe cases; but the improved methods

now used are free from danger, and may be performed without the aid of an anæsthetic, and without occasioning any great degree of pain.

Impotence. — Almost the sole cause of impotence is sexual excess of some kind, and the disease is in a great number of cases the result of self-abuse and unnatural coitus. The first symptom of approaching impotence is too early ejaculation, which is soon followed by loss of sexual power. The primary cause of the disease is exhaustion of the nerve centers which control the sexual organs. In a great share of these cases, nocturnal losses, or true spermatorrhœa, is present with all the accompanying symptoms of this disorder, particularly an irritable condition of the urethra. The majority of cases of impotence which have not been seriously mistreated, may be relieved, if they have not existed for too great a length of time. In persons far advanced in years, who have become impotent through the natural decline of the vital powers, no measure of treatment can afford more than temporary relief. In young men who are suffering with complete or partial loss of sexual ability as the result of excesses, the disease can usually be cured by the adoption of proper methods in the hands of an experienced physician. The patient may employ advantageously the regimen and treatment suggested for seminal weakness, which will be found of great service in conjunction with any other measures of treatment that may be instituted. We would warn persons suffering in this way against the use of aphrodisiac remedies, or sexual stimulants, as the ultimate results of such measures are the very worst possible, and no cases are so hopeless as those which have been mistreated in this way.

Sterility. — Sterility is by most men supposed to be a disease confined almost exclusively to the other sex; but careful researches have shown that when married couples are childless, the fault is with the husband in not less than one case out of six. Want of procreative power may be due to disease, or deficient development of the testicles, or entire absence of the organs. It may also arise from obstruction of some portion of the seminal ducts, from disease of the seminal fluid, catarrhal or bloody discharges from some portion of the urinary passages, too frequent sexual indulgence, seminal losses, catarrh of the prostate, absence of spermatozoa, consumption, syphilis, nervous debility, and diseases of the brain and kidneys. The management of diseases of this kind requires the greatest skill on the part of the physician, and cannot be left to the patient himself, and hence few remarks concerning treatment are needed here. Many cases are incurable from their very nature; but cases in which the sterility is the result of abnormal discharges, are cured by correcting the discharge.

Gonorrhœa. — This disease, vulgarly known as clap, was until recently considered a specific disorder, but is now believed to be simply a catarrhal inflammation of the urethral mucous membrane, which may be originated by other causes than that of impure sexual connection. Intemperance, excessive coitus, leucorrhœal discharge, exposure of the perineum to cold, — all these and possibly other causes may give rise to a genuine gonorrhœal inflammation. The disease is usually confined to the urethral canal, but may affect other portions of the penis, as the head of the organ and the foreskin. Its usual course is from the orifice of the urethra in-

ward. It may be confined to the mucous membrane, but usually involves the deeper structures. In severe cases, the inflammation may reach into the surrounding tissues so extensively as to cause distortion of the shape of the organ by contraction and obstruction of the urethral canal, or stricture and various other deformities may be produced.

Symptoms. — The first symptoms of the disease are usually noticed two or three days after exposure. The first manifestations are itching, tingling, or simply slight uneasiness about the meatus, or mouth of the urethra, which on examination is found to be red and slightly stuck together by a viscid, colorless secretion. The discharge is at first very slight, but increases rapidly, and soon becomes thick and yellowish. On passing urine, a slight smarting sensation is felt. The disease may remain at this stage any length of time, from half a day to two or three days. Sooner or later, however, the symptoms become much aggravated through extension of the disease into the deeper portions of the urethra, and the whole organ becomes swollen and tender, the discharge thick and green, and the passage of urine occasions a severe scalding sensation. Violent erections are frequently experienced, as is also chordee, a condition in which the organ is drawn into the shape a bow during erections, a very painful and distressing condition.

In simple cases which pursue a natural course, the inflammation subsides after one to six weeks; but in many cases it will continue indefinitely, if not properly treated, in the form of gleet, which sometimes lasts for years. In this form of the disease, the discharge may

be so slight as to be readily overlooked, but may be detected by pressing the urethra from behind forward. By this means a few drops of milky discharge can be squeezed out at the orifice of the urethra.

One of the most serious and frequent results of this disease is stricture, the extent of which may vary from the very slightest degree of obstruction to complete closure of the canal. The possible consequences of a stricture are the very worst imaginable; and a person who has acquired this unfortunate condition, is certain to be subjected to many inconveniences, and may be compelled to endure great suffering therefrom. A person finding himself afflicted with this disorder, should at once seek a skillful physician for advice, and should give the matter serious attention until the disease is wholly eradicated.

Chancroid. — This disorder, sometimes termed simple venereal ulcer, was until recently regarded as a form of true syphilis. It is now known to be simply a local disease. It is an infectious, eating ulcer, which progresses rapidly when left to itself, and sometimes destroys a very considerable portion of the part attacked. The ulcer usually makes its appearance within one to two hours after exposure. Buboes, or hard swellings in the groin, often appear in connection with this disease. Chancroid, sometimes termed soft chancre, is distinguished from the ulcer which marks the beginning of true syphilis by the fact that the tissues surrounding it are soft, while in true chancre the sore has a hard or indurated feeling. Another peculiarity of the soft chancre is that if a portion of the discharge, which is very copious, is introduced beneath the skin, or applied to a

raw surface in any way, a new sore is produced, whereas the sore of true syphilis is not capable of being propagated by inoculation in the same individual.

This disorder requires vigorous and prompt attention; and a person suffering with it should place himself immediately under the care of a thoroughly competent physician. One of the most essential features of the treatment of this class of cases, is thorough cleanliness.

Syphilis. — The symptoms of this disease are too numerous for full consideration here, and we can only notice some of the chief features of the disease. It has three distinct stages. The first is a local manifestation, known as chancre. Two or three weeks, or longer, after exposure, a small, hard, reddish pimple makes its appearance, usually upon the genitals, although cases have occurred in which the disease was contracted by kissing, when the chancre was formed upon the lip. The pimple increases in size for a few days, and finally ulcerates, and discharges slightly. It does not usually give much inconvenience, and is, in fact, not infrequently unnoticed. In this respect, chancre differs very materially from chancroid, — a very important distinction. After a few days the glands of the groins become somewhat enlarged, although not very painful. After one to three months the secondary stage of the disease appears, as an eruption of red spots, which are followed by pimples. After a time, larger pimples or pustules make their appearance, leaving behind them pock marks like those of small-pox. Ulcers also appear in some cases. Stimultaneously{sic} with the occurrence of the eruption, slightly raised spots of a whitish color, known as mucous patches, appear on the mucous membrane of the lips and tongue and throat. A

slight discharge arises from these patches, which is of a very contagious character. The patient also has sore throat, and often sore eyes; and after the general health has become considerably impaired, suffers greatly with pain in the head, arms, legs, breast, and particularly in the joints, though the pain is not confined to them as in rheumatism. Small swellings, known as nodes, which are tender on pressure, appear on the, shins and other parts.

Most of the above symptoms usually disappear after a few weeks, and the patient may seem to be well for several months or years; but unless the disease has been properly treated, it is all the time at work in the system, and next makes its appearance in the deeper tissues, particularly in the bones and cartilages of the nose and skull. Not infrequently the nose is greatly disfigured, or even wholly destroyed. The liver, lungs, kidneys, heart, and other internal organs, are also likely lo be affected. No other disease makes such fearful ravages in the human constitution as this, or subjects its victims to such horrible sufferings and disfigurements. It is also one of the most certainly communicable by heredity, of all diseases; and it is not possible for a physician to say to a person suffering with this disease, at any time, no matter how long treatment has been received, that he is cured, and may safely marry. Let every man whose blood is yet pure, consider soberly whether he can afford to run the fearful risk of contamination with such a malady.